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目的:肾造瘘通道的建立是经皮肾镜取石术(PCNL)的关键步骤,近年来我们建立了一种新的刺激性利尿一步扩张法通道建立技术,摈弃了传统的输尿管逆行插管操作和多步扩张操作,极大的简化了操作步骤。本文拟研究该通道建立技术在PCNL手术中的安全性和有效性。方法:选取2014年8月~2015年3月顺序入院的50例复杂性肾脏输尿管结石患者为研究对象。所有患者均采用刺激性利尿一步扩张法通道建立技术行PCNL手术。患者麻醉完善后,先留置导尿管,予以夹闭,同时静脉输注生理盐水500~1 000 ml。改为俯卧位后,静脉输注40mg速尿,6min后开始进行肾脏集合系统穿刺和通道扩张操作。观察和记录通道建立时间、整体手术时间、肾脏出血量、总肾功能变化、结石碎片下移进入输尿管例数、通道建立失败例数、集合系统穿孔、输血例数和输血量等研究指标。结果:所有患者均可诱导出肾盏颈管扩张,均成功一次建立取石通道,无通道建立失败和集合系统穿孔病例,无需要输血治疗病例。通道建立时间为(1.9±0.5)min,整体手术时间为(34.6±23.8)min,一次手术结石取净率为88%。结论:本研究结果表明,在PCNL手术中采取刺激性利尿一步扩张法通道建立技术是可行的、有效的和安全的,值得临床进一步推广应用。
OBJECTIVE: The establishment of nephrostomy channel is the key step of percutaneous nephrolithotomy (PCNL). In recent years, we have established a new channel-establishing technique for stimulating diuretic one-step expansion, which has abandoned the traditional retrograde ureteral catheterization And multi-step expansion operation, which greatly simplifies the operation steps. This article intends to study the safety and effectiveness of the channel-building technique in PCNL surgery. Methods: Fifty patients with complicated renal ureteral calculi admitted from August 2014 to March 2015 were enrolled in this study. All patients were treated with stimulating diuretic one-step dilation channel to establish PCNL technique. Patients anesthesia improved, first indwelling catheter, to be closed, while intravenous infusion of saline 500 ~ 1 000 ml. To prone position, intravenous infusion of 40mg furosemide, 6min after the start of the renal collection system puncture and channel expansion. Observation and record of channel establishment time, overall operation time, renal bleeding, total renal function changes, stone fragments down into the ureter number, failed to establish the number of channels, collecting system perforation, blood transfusion and blood transfusion and other indicators. Results: All patients were able to induce the dilatation of the calyces of the calyces of the calyces. All of them were successful in establishing a stone-taking channel, failed to establish the channel, and perforation of the collection system without the need of transfusion. The channel establishment time was (1.9 ± 0.5) min, the overall operation time was (34.6 ± 23.8) min, the rate of primary operation stone removal was 88%. Conclusion: The results of this study show that it is feasible, effective and safe to establish the technique of stimulating diuretic one-step dilation channel in PCNL surgery, so it is worth further clinical application.